Hospital Readmissions. They’re Kind of a Big Deal

About 1 in 5 Medicare patients is readmitted within 30 days of discharge from a hospital

Unplanned readmissions cost Medicare $17.4 billion per year

Up to 20% of patients discharged from an acute care hospital suffers an adverse event within 3 weeks, 75% of which are considered potentially preventable

Potentially 27% of all readmissions are potentially preventable, and up to 50% of those are linked to interventions that could have been provided during initial hospitalization

What current measures are in place to reduce readmissions?

Under the Affordable Care Act (ACA), the Hospital Readmissions Reduction Program (HRRP) applies penalties to hospitals with above average readmission rates for select conditions. For FY2017, fines totaling approximately $528 million are being levied to 79% of hospitals under the program (Boccuti & Casillas, 2017).

Other initiatives under the ACA, such as Accountable Care Organizations, bundled-payment initiatives, and medical home programs, include provider incentives to lower hospital readmission rates. In addition, CMS has started allowing physicians to bill Medicare for transitional care management after a beneficiary’s discharge from a hospital or other type of healthcare facility.

Chances are, if you work in a role even remotely related to healthcare, efforts to reduce hospital readmissions have impacted your job, and for many it is a central focus. With so much at stake, healthcare providers, professionals, policymakers, and payers are fervently seeking sustainable solutions. An extensive range of strategies have been studied and recommended to reduce readmissions and a wide spectrum of single and multi-component interventions have been implemented across the continuum of care. However, questions still loom as to the most effective and efficient use of resources for improvement.

Framework of Care Transition Created from National Study

Furthermore. in 2015, a national study was conducted to identify strategies hospitals were using and which ones had the greatest impact on desired outcomes. Over 400 hospitals participating in 1 or more federal transitional care strategies completed a survey on their initiatives. The study revealed 302 unique combinations in practice (Mays, Strombert, Guo, & Williams, 2016). Hansen and colleagues (2011) conducted a review of 43 interventions to reduce readmissions finding “no consistent evidence from randomized controlled trials that any one intervention by itself significantly reduced hospital readmissions.”

Based on supporting evidence, Burke and colleagues (2013) developed a framework of care transition intervention domains that span inpatient and outpatient settings, called the Ideal Transition in Care. It describes 10 “ideal” components that fall along a spectrum from discharge planning to outpatient follow-up depicted as a bridge patients cross from one care environment to another saying, “it implies that the more components are missing, the less safe the ‘bridge’ or transition is.”

A review of 61 interventions, including singular and bundled multi-component interventions, were mapped to the Ideal Transition in Care framework. The average number of domains included in interventions was found to be 3.5 with 47.5% demonstrating reductions in readmissions. Consistent with other studies, no singular intervention improved readmissions. In fact, the only significant predictor of success was the number of domains included in an intervention. In other words, the more domains employed, the greater the likelihood of reducing rates of readmissions.

As a registered nurse for more than 27 years, Rebecca has experience across a wide spectrum of settings, including: rural and urban hospitals in medical/surgical, and ED clinical roles; school nursing; public health epidemiology; ambulatory surgery center; infection control; quality management; organizational development; and education in hospital, academic, and commercial organizations. She has authored a myriad of live and web-based courses on over 50 regulatory topics, patient safety, patient experience, and others. Her passion for education developed over the course of her career while helping patients, professionals, and organizations leverage learning to achieve their goals. Improving patient care by helping others gain new knowledge, skills, and attitudes is her mission and the driving force behind her work.